Ding Dale, Starke Robert M, Manka David, Crowley R Webster, Liu Kenneth C
Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
Interv Neuroradiol. 2015 Dec;21(6):738-41. doi: 10.1177/1591019915609132. Epub 2015 Oct 13.
Spinal arteriovenous fistulas (AVFs) completely isolated to the epidural compartment are exceedingly rare. As such, the optimal management of these lesions is poorly defined. The aim of this technical note is to describe our endovascular technique for the occlusion of a purely epidural AVF of the thoracic spine associated with cord compression from an associated enlarging venous varix. A 40-year-old male presented with severe right-sided back pain and anterior thigh numbness after a sports-related back injury six months previously. Spinal magnetic resonance imaging (MRI) showed an enhancing, extradural mass lesion at T12. Spinal angiography revealed an epidural AVF supplied by a radicular branch of the right T12 subcostal artery and draining into the paravertebral lumbar veins, as well as an adjacent 20 × 13 mm(2) contrast-filling sac, compatible with a dilated venous varix. There was no evidence of intradural venous drainage. We elected to proceed with endovascular treatment of the lesion. At the time of embolization five days later, the venous varix had enlarged to 26 × 16 mm(2). The T12 epidural AVF was completely occluded with two coils, without residual or recurrent AVF on follow-up angiography one month later. The patient made a full recovery, and complete resolution of the venous varix and cord compression were noted on MRI at three months follow-up. Endovascular coil embolization can be successfully employed for the treatment of appropriately selected spinal epidural AVFs. Cord compression from an enlarging venous varix can be treated concurrently with endovascular occlusion of an associated spinal epidural AVF.
完全局限于硬膜外腔的脊柱动静脉瘘（AVF）极为罕见。因此，对于这些病变的最佳治疗方法尚无明确界定。本技术报告的目的是描述我们采用血管内技术闭塞胸椎单纯硬膜外AVF并伴有因相关静脉扩张导致脊髓受压的情况。一名40岁男性在6个月前因运动相关的背部损伤后出现严重的右侧背痛和大腿前部麻木。脊柱磁共振成像（MRI）显示T12水平有一个强化的硬膜外肿块病变。脊柱血管造影显示一个硬膜外AVF，由右侧T12肋下动脉的一个根部分支供血，引流至椎旁腰静脉，还有一个相邻的20×13mm²的造影剂充盈囊，符合扩张的静脉扩张。没有硬膜内静脉引流的证据。我们选择对该病变进行血管内治疗。五天后进行栓塞时，静脉扩张已增大至26×16mm²。用两个弹簧圈完全闭塞了T12硬膜外AVF，一个月后的随访血管造影显示没有残留或复发性AVF。患者完全康复，在三个月的随访MRI中发现静脉扩张和脊髓压迫完全消退。血管内弹簧圈栓塞可成功用于治疗适当选择的脊柱硬膜外AVF。因静脉扩张导致的脊髓压迫可与相关脊柱硬膜外AVF的血管内闭塞同时进行治疗。
